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Toshner M, Voswinckel R, Southwood M, Al-Lamki R, Howard LSG, Marchesan D, Yang J, Suntharalingam J, Soon E, Exley A, Stewart S, Hecker M, Zhu Z, Gehling U, Seeger W, Pepke-Zaba J, Morrell NW. Evidence of dysfunction of endothelial progenitors in pulmonary arterial hypertension. Am J Respir Crit Care Med 2009; 180:780-7. [PMID: 19628780 PMCID: PMC2778151 DOI: 10.1164/rccm.200810-1662oc] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 07/22/2009] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Severe pulmonary arterial hypertension (PAH) is characterized by the formation of plexiform lesions and concentric intimal fibrosis in small pulmonary arteries. The origin of cells contributing to these vascular lesions is uncertain. Endogenous endothelial progenitor cells are potential contributors to this process. OBJECTIVES To determine whether progenitors are involved in the pathobiology of PAH. METHODS We performed immunohistochemistry to determine the expression of progenitor cell markers (CD133 and c-Kit) and the major homing signal pathway stromal cell-derived factor-1 and its chemokine receptor (CXCR4) in lung tissue from patients with idiopathic PAH, familial PAH, and PAH associated with congenital heart disease. Two separate flow cytometric methods were employed to determine peripheral blood circulating numbers of angiogenic progenitors. Late-outgrowth progenitor cells were expanded ex vivo from the peripheral blood of patients with mutations in the gene encoding bone morphogenetic protein receptor type II (BMPRII), and functional assays of migration, proliferation, and angiogenesis were undertaken. measurements and main results: There was a striking up-regulation of progenitor cell markers in remodeled arteries from all patients with PAH, specifically in plexiform lesions. These lesions also displayed increased stromal cell-derived factor-1 expression. Circulating angiogenic progenitor numbers in patients with PAH were increased compared with control subjects and functional studies of late-outgrowth progenitor cells from patients with PAH with BMPRII mutations revealed a hyperproliferative phenotype with impaired ability to form vascular networks. CONCLUSIONS These findings provide evidence of the involvement of progenitor cells in the vascular remodeling associated with PAH. Dysfunction of circulating progenitors in PAH may contribute to this process.
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Affiliation(s)
- Mark Toshner
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Robert Voswinckel
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Mark Southwood
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Rafia Al-Lamki
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Luke S. G. Howard
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Denis Marchesan
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Jun Yang
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Jay Suntharalingam
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Elaine Soon
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Andrew Exley
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Susan Stewart
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Markus Hecker
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Zhenping Zhu
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Ursula Gehling
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Werner Seeger
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Joanna Pepke-Zaba
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Nicholas W. Morrell
- Papworth Hospital and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Department of Internal Medicine, University of Giessen Lung Center, Giessen, Germany; Hammersmith Hospital, London and Royal United Hospital, Bath, United Kingdom; Department Antibody Technology, ImClone Systems, Inc., New York; and Department of Medicine, University Hospital Eppendorf, Hamburg, Germany
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